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Outcomes in pediatric cardiac transplantation with a positive HLA cross‐match
Author(s) -
Richmond Marc E.,
Hsu Daphne T.,
Mosca Ralph S.,
Chen Jonathan,
Quaegebeur Jan M.,
Addonizio Linda J.,
Lamour Jacqueline M.
Publication year - 2012
Publication title -
pediatric transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.457
H-Index - 69
eISSN - 1399-3046
pISSN - 1397-3142
DOI - 10.1111/j.1399-3046.2011.01555.x
Subject(s) - medicine , heart transplantation , transplantation , cross sectional study , cardiomyopathy , single center , cardiology , surgery , heart failure , pathology
Richmond ME, Hsu DT, Mosca RS, Chen J, Quaegebeur JM, Addonizio LJ, Lamour JM. Outcomes in pediatric cardiac transplantation with a positive HLA cross‐match.
Pediatr Transplantation 2012: 16: 29–35. © 2011 John Wiley & Sons A/S. Abstract: Previous studies have shown poor outcomes in pediatric heart transplant recipients with a high PRA or a positive direct donor–recipient cross‐match. This study describes outcomes in patients with a positive cross‐match at a large pediatric program. Pediatric heart transplant patients at a large single center between January 1993 and July 2009 were reviewed; those with cross‐match data were analyzed. Cross‐match data were available in 242/262 (92.4%) patients. Indications for transplant were cardiomyopathy (58%), CHD (32%), and retransplant (7%). PRA was ≥10% in 31/213 (14.6%) patients. A retrospective cross‐match was positive in 17/31 (55%) patients with PRA ≥10% and 0/182 with PRA <10%. In positive cross‐match patients, rejection frequency in the first year post‐transplant was higher than negative cross‐match patients (1.69 vs. 0.96 episodes/pt year, p = 0.014). There was no difference in rejection frequency after the first year post‐transplant (0.18 vs. 0.12 episodes/pt year, p = 0.14). Overall survival was not significantly different between the groups with a median follow‐up time of 4.5 yr. Heart transplantation in patients with a positive cross‐match may result in good medium‐term survival but a higher frequency of early rejection. Further investigation is warranted to define which patients with a positive cross‐match will do poorly.